I.

INTRODUCTION
A. Brief description

Preeclampsia is a disorder of widespread vascular endothelial malfunction and

vasospasm that occurs after 20 weeks of gestation and can present as late as 4-6 weeks
postpartum. It is clinically defined by hypertension and proteinuria, with or without pathologic
edema (Lim, 2018). According to Klossner and Hatfiled (2008), preeclampsia is a serious
condition of pregnancy in which the blood pressure rises to 140/90 mmHg or higher accompanied
by proteinuria (> 0.3 mg/dl). The underlying cause of this disorder is unknown. Some theories
include endothelial cell injury, compromised placental perfusion etc.

In the study of Lim (2018), there are 2 categories of the disease mild and severe. Signs
and symptoms of preeclampsia include headache, visual disturbances, altered mental status,
edema (facial and pitting), epigastric pain, generalized weakness or malaise and clonus
(increased risk of convulsion).

Risk factors for preeclampsia and their odds ratios are having a family history of
preeclampsia-eclampsia, African American descent, nulliparity, pre-existing medical conditions
such as chronic hypertension, systemic lupus erythomatosus, renal diseases and diabetes
mellitus. Obstetric complications including multiple gestation, hyatidiform mole, twin gestation and
high body mass index (Lim, 2018). In addition, Klossner & Hatfield (2008) said that women
younger than 20 years old and older than 35 years old have increased risk of having
preeclampsia. If not treated well, it can lead to eclampsia, a severe form of preeclampsia that
leads to seizures in the mother. In the study of Cousens, et al. (2011), another complication is the
HELLP syndrome, a condition usually occurring late in pregnancy that affects the breakdown of
red blood cells, how the blood clots, and liver function for the pregnant woman.

B. Current Trends

In the study of Kuklina, et al. (2010), ten million women develop preeclampsia each year
around the world. Worldwide 76,000 pregnant women die each year from preeclampsia and
related hypertensive disorders. And the number of babies who die from these disorders is thought
to be on the order of 500,000 per annum. Moreover WHO (2007), stated that in the developing
countries, a woman is seven times as likely to develop preeclampsia as a woman in a develop
country. From 10-25 % of these cases will result in maternal deaths.

In the Philippines, according to Department of Health, Maternal Mortality Rate (MMR) is

162 out of 10,000 live births (DOH, 2015).

C. Reason for choosing the case

We always heard about preeclampsia before but honestly there are many things we still
do not understand, and this is one of the reasons for us choosing this case. We also want to
impart our knowledge and skills in improving the health condition and lifestyle of our patient using
the nursing process.

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 D. Objectives

General Objectives:

At the end of the rotation we the BSN- 4A, Group A2 will expand our knowledge, skills and
attitude in the care and management of patient who has complication in pregnancy like
preeclampsia. Utilizing the nursing process, we will seek to improve the health care status of the
patient and provide health teachings on modification in her comfort and significance of healthy
lifestyle.

Specific Objectives:

At the end of this case, the group will able to:

1.) Assess the general health status, routines of daily living as well as health lifestyle
factors affecting the health condition of the patient
2.) Identify and prioritize nursing problems and formulate nursing diagnoses based on
gathered data
3.) Plan efficient nursing care to solve identified problems based from patient’s health
status and needs.
4.) Implement and render suitable nursing care that will improve patient’s health
5.) Evaluate the effectiveness of nursing interventions rendered to improve patient’s
condition for possible discharge.

II. NURSING PROCESS

A. ASSESSMENT
1. PERSONAL DATA

a. Demographic Data

Name: Patient X

Age: 35 years old

Address: Tarlac City

Gender: Female

Civil Status: Married

Date of birth: June 12, 1983

Nationality: Filipino

Religion: Roman Catholic

Occupation: Housewife

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Admitting Diagnosis: G5P4 (4004) Pregnancy uterine 38 weeks’ age of gestation cephalic in
labor, chronic hypertension with superimposed preeclampsia.

Final Diagnosis: G5P5 (5005) Pregnancy uterine delivered term cephalic to a live baby boy,
Apgar score of 8, 9, weight 2.8 kg, appropriate for gestational age by normal spontaneous
delivery, with superimposed preeclampsia.

Date Admitted: January 28, 2019

Time Admitted: 9:34 am

b. Environmental Status

Patient X is a 33-year-old patient who lives in a rural area along the highway. They are
nuclear type of family. They live in the mixed type of house which is both cement and wood
consisting of three rooms each room had one window with two main doors and one comfort room.
Their source of drinking water is mineral water. When it comes to the waste disposal, they burn it
and there were times they collect it especially the plastic. The type of drainage system is open
drainage and the water is free flowing. At beside of their house there were mango and vegetables
like eggplant and malunggay planted. The distance from their neighbors is 5 meters away.

c. Lifestyle (habits, recreation, hobbies)

Patient X eats her meals two times a day but three times a day sometimes, mostly just
drinking coffee with crackers every morning. She is fond of eating fatty foods especially chicharon,
salty foods, and junk foods most commonly ever snack that she eats is junk food even during her
pregnancy. According to her she can drink water more than two litters per day. After her household
chores, she spent time on chatting and watching televisions. She sleeps 6-7 hours.

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 2. Family history of health and illness

GENOGRAM

Maternal Paternal

Brother 40 Brother 37 Pt. 33

Legend:

male female male HTN female HTN stroke deceased Patient

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 3. History of Past Illness
Patient X claims a complete immunization during her childhood. She has no serious
injuries and accidents experienced before but she experienced having common illnesses like
measles, chicken pox, mumps, cough, colds, and fever wherein she was taking over the counter
drugs (OTC). Her high blood pressure started after her miscarriage during his 4th pregnancy. She
was not aware that she was pregnant because she was diagnosed with myoma and anemia
before her 4th gravida. She fainted and ignored it because she thoughts that it was due to her
myoma and anemia. when she fainted at the second time, she went to hospital and she knew that
her baby died during pregnancy. She was given a blood pressure maintenance of amlodipine and
losartan to her blood pressure reading of 190/120. Her following pregnancy (G5), she was
diagnosed with preeclampsia.

4. History of Present Illness

Bipedal pitting edema was observed by patient X at her third trimester of pregnancy. she
also had experienced difficulty of breathing and headache. She had difficulty of sleeping prior to
confinement due to his abdominal pain and severe headache. Her symptoms alleviated at rest

1 hour prior to confinement, ruptured of membrane occurred at their house which prompt
her to go to hospital. She was admitted at Tarlac Provincial Hospital, ER department with a
complaint of ruptured of membrane. She also experienced head ache and dizziness as stated by
her. BP was recorded 180/120. Bipedal pitting edema measured 2mm/5 seconds and considered
as Grade 1.

Parameter

13 Areas of Assessment

I. SOCIAL STATUS

Ante-partum

Patient X is a 35-years old female born on June 12, 1983. She is married and has three
children, and they’re all currently residing at Paniqui, Tarlac City. She is not working, but she
sometimes helps out with the laundry of her neighbors. Her husband is a farmer and has a sideline
job as a construction worker. Her three children are currently studying, her eldest is in college the
second and third are in grade 11 and grade 10. The husband is their primary provider for their

5
living. She is fully supported by her husband and she is friendly to her neighbor which she
considers the advices of the elders. Her families support and love helps her when she gets
stressed. However, when we interviewed her, she told us that sometimes, she gets irritated and
scolds her children when she has lack of sleep and have a headache, but her family is very
understanding with it and those also affects her social life, like she will just stay at home rather
than interacting with her neighbors.

Post-partum

Her hospital bills are supported by their family savings.

NORMS:

Social status includes family relationships that state the patient’s support system in time
of stress and in time of need. It meets a fundamental human need for socialites making life less
stressful and social support buffers the negative effects of stress, thus indicating indirectly
contributing to good health outcomes (Kozier, B., “Fundamentals of Nursing” Seventh Edition).

ANALYSIS/INTERPRETATION:

The support, love and understanding that she receives from her family helps her cope up
with stress and even with her pregnancy.

II. MENTAL STATUS

Ante-partum

The patient is conscious and coherent, oriented to time and place. She is a high school
undergraduate and could follow instructions well like lying on her left side. She can maintain eye
to eye contact during the interview. She answers all the questions well but in a weak tone because
she was in pain.

Post-partum

She was able to read and write properly. She was able to remember the pain and remote
memories when she was in labor. No signs of postpartum blues seen. She was able to hold her
baby at ease and told us that she is happy when she holds and see her baby.

NORMS:

The patient should be oriented to time and place, can identify past and recent memories
and should be able to verbalize concrete messages. The patient’s ability to read and write should
match his educational level. The patient should be able to respond to questions and identify all
the objects presented to him. The patient should be able to evaluate and act appropriately in
situation (Estes Health Assessment and Physical Examination Third Edition.)

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ANALYSIS/INTERPRETATION:

She wears clothes accurately in her pregnancy. She was able to remote her memory during
her labor process. She is responsive and readily aroused. She can interpret the situation and
draw logical conclusion. No postpartum blues was observed.

• APPEARANCE AND MOVEMENT

Ante-partum

The first time we saw her, she looked weak, her hygiene was poor as we observed. She
was uneasy and grimaces from time to time. She can sit and stand by herself or with the help of
others. Her hair is disheveled and there is presence of dandruff.

Post-partum

She was seen smiling and doesn't grimace anymore, could sit and stand alone. Her
hygiene has improved, and her hair is no longer disheveled.

NORMS

The client must be relaxed with the shoulders back and both felt stable, smooth, coordinate
movement. Skin and nails are clean and trimmed. And has a good eye contact, smiles/ frowns
appropriately (Jarvis, C., “Physical examination & health assessment”, 6th Edition).

ANALYSIS/INTERPRETATION:

As we observed her the first time, she looks weak and grimaces from time to time due to
her pregnancy. She can stand and sit alone or with someone's help. Her hygiene was poor, and
her hair is disheveled. In our last observation, she is more active and energetic. Her hygiene has
improved, and her hair is no longer disheveled

• ORIENTATION

She is aware of herself and knows her significant others. She is aware that she is currently
confined at Tarlac Provincial Hospital as well as the date and time.

NORMS

Aware of self, others, place, time, and address (Jarvis, C., “Physical examination & health
assessment”, 6th Edition).

ANALYSIS/INTERPRETATION

She knew the time, place and the people surrounding her.

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 • SPEECH

Ante-partum

She responded in a weak tone and we observed that she is not at ease when talks to us.
She paused or stop talking when she is in pain. And sometimes, slurred speech is noted, some
of her words are not pronounced properly

Post-partum

When we revisited her again, she responds lively.

NORMS

Speech should be clear and moderate in pace (Estes Health Assessment and Physical
Examination Fifth Edition).

ANALYSIS/INTERPRETATION

She was having difficulty in delivering her speech when she was in pain but after during
her postpartum, she gained her strength and responds livelier compare the antepartum period.

• INTELLECTUAL FUNCTIONING

Ante-partum

She understands what we are saying and answers when being asked. She listens and
responds well.

NORMS

Respond appropriately to topics discussed. Express full and free-flowing thought during
interview and listens and respond with full thoughts (Estes Health Assessment and Physical
Examination Fifth Edition).

ANALYSIS/INTERPRETATION

The first time we interviewed her, she understands and answers the questions being
asked without difficulty. she listens well and responds attentively.

III. EMOTIONAL STATUS

Ante-partum

Patient X is afraid about what will going to happen upon her delivery. The patient has a
worried look on her face and grimaces from time to time due to the pain upon contractions.

Post-partum

On our next visit, the patient was able to smile and looked relieved after the delivery. She
told us that she is happy that her baby came out already.

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NORMS:

During pregnancy, the birth of your baby and the postnatal period, changes in the
hormones in your body can have an effect on your emotions during pregnancy. Emotional
reactions will also inevitably come up when a new baby is added to your family (Estes,
M.E.,”Health Assessment and Physical Examination”, 4th Edition).

ANALYSIS/INTERPRETATION:

The patient enters the taking-hold phase in emotional adaptation wherein she initiates
actions on her own and making decisions without relying on others.

IV. SENSORY PERCEPTION

• Sense of sight

Ante-partum

With the use of a paper with a written word “baby” she is able to identify it in a near distance
but complaining that she has blurry vision. With the use of penlight, the following were observed,
pupils constrict when struck by light, patient’s eyes are symmetrical and round, Sclera is slightly
yellow in color and eyes are symmetrical in moving. And according to her, she doesn’t wear any
graded lenses.

Post-partum

She can focus and response accurately to the given activity.

NORMS:

The normal vision of an average person is 20/20 in distance of 20 feet away and doesn’t
wear any corrective graded lenses (Estes, M.E.,”Health Assessment and Physical Examination”,
4th Edition).

ANALYSIS/INTERPRETATION:

Patient X was showing one of the symptoms of preeclampsia which is blurry vision.

• Sense of smell

Ante-partum

We use a perfume and alcohol for this examination, but before we start, we asked her if
she has colds or any nasal secretions. Then, we let her close her eyes and identify what is the
perfume and alcohol. We let her smell the perfume on the left side of her nose and alcohol on the
right side. She is able to identify and sort out which is alcohol and perfume.

Post-partum

She still able to identify and sort out which is alcohol and perfume.

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NORMS:

The normal person can smell and identify the aroma of a given object like perfume or any
other. The person should be able to distinguish the foul to a good smelling thing but it can be
deviated if the person has colds or a problem in his nasal sinuses (Estes, M.E.,”Health
Assessment and Physical Examination”, 4th Edition).

ANALYSIS/INTERPRETATION:

The patient has a normal smelling capability.

• SENSE OF HEARING

Ante-partum

We use the voice whisper test method. A word was whispered, and the patient was
instructed to repeat the words that were whispered. The procedure was then repeated to the other
ear.

Post-partum

We repeat the voice whisper test method again and she still repeat the words correctly
without difficulty.

NORMS:

The auditory of the person is normal if the patient don’t have a tinnitus or any ear problem.
He should be able to hear in the minimum of 2 feet away (Estes, M.E.,”Health Assessment and
Physical Examination”, 4th Edition).

ANALYSIS/INTERPRETATION:

The patient has a normal hearing ability and doesn’t indicate any ear or hearing problem
in her current condition. She does not wear or take any hearing aids.

• SENSE OF TOUCH

Ante-partum

By instructing the patient to close her eyes, we pinched at the elbow of the patient and the
patient was able to identify the area being pinched properly with pain being felt.

Post-partum

The patient is responsive and became more sensitive.

NORMS:

The Tactile sensitivity or hypersensitivity is an unusual or increased sensitivity to touch

that makes the person feel peculiar, noxious, or even in pain. It is also called tactile defensiveness
or tactile over-sensitivity. Like other sensory processing issues, tactile sensitivity can run from
mild to severe. (Estes, M.E.,”Health Assessment and Physical Examination”, 4th Edition).

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ANALYSIS/INTERPRETATION:

She terminated painful stimulus and responsiveness was elicited.

• SENSE OF TASTE

Ante-partum

According to the patient, she has no allergies and she is not picky in foods. She doesn’t
crave for a food that a normal pregnant woman does.

Post-partum

Before we let her close her eyes again, we explained to her that she needs to differentiate
what is the sour candy and sweet candy on the paper that she will taste. When she closed her
eyes, she tasted them, and she can differentiate the difference between the two.

NORMS:

A person usually identifies the taste of bitter, sweet and sour. By the use of our sense of
taste we can fix or adjust the taste of our cooked food base on our tasting capacity (Estes, M.E.,”
Health Assessment and Physical Examination”, 4th Edition).

ANALYSIS/INTERPRETATION:

Patient X has a good appetite and her sense of taste is not impaired.

IV. MOTOR STABILITY

Ante-partum

By instructing the patient to move her arms upward and open her legs widely, the patient
was able to comply in a given instruction with pain due to pain in contractions. According to the
patient, during her ante-partum period, the patient is walking every morning as part of her
exercise.

Post-partum

We asked the patient to open her eyes and squeeze her hand, and the responsiveness is
noted.

NORMS:

Late adulthood is in the stage where neuron loss continues with associated decrease in
cerebral flow. Reaction times slow due to decreased levels of neurotransmitter. Gait and balance
are affected with decreased proprioception. (Focus on Pathophysiology by Bullock and Henze).
The patient with ascites maybe short of breath and uncomfortable from enlarge abdomen (Jarvis,
C., “Physical examination & health assessment”, 6th Edition).

ANALYSIS/INTERPRETATION:

The patient has a responsive stimulus.

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VI. BODY TEMPERATURE

Temperature was taken by using an axillary thermometer at the left axilla, the temperature reading
was:

DATE TIME TEMPERATURE ANALYSIS

January 28, 2019 10:20 AM 35 ºC BELOW NORMAL
Ante-partum 10:35 A.M. 36 ºC NORMAL
11:00 A.M. 36.8 NORMAL
January 29, 2019 3:00 P.M. 37.9 ºC ABOVE NORMAL
Post-partum

NORMS

Extra blood flow boosts body metabolism by about 20%, creating more body heat and
making pregnant women less likely to feel the cold. A pregnant woman’s core body temperature
will often rise to about 37.8°C, when it is normally 37°C (Jarvis, C., “Physical examination & health
assessment”, 6th Edition).

ANALYSIS/INTERPRETATION:

As evidence by the table above, on her first day, her temperature is below normal but after
a while it normalized. The second day of our follow up she got puerperal fever.

VII. RESPIRATORY STATUS

Antepartum

Respiratory rate of the patient was above the normal range. Rapid and shallow respiration
was observed upon contractions. She had difficulty of breathing wherein we placed the patient
into semi fowler’s position and encouraged and demonstrated proper breathing exercise, but still
having difficulty, the patient requested to be connected to supplemental oxygen.

Postpartum

Patient’s respiratory rate was still above normal range. The exertion of more effort and
use of accessory muscles in breathing was observed.

DATE TIME RESPIRATORY ANALYSIS

RATE
January 28, 2019 10:20 am 20cpm Normal
(Ante-partum) 10:35 am 28cpm Above normal
11:00 am 25cpm Above normal

January 29, 2019 3:00 pm 24 cpm Above normal

(Post-partum)

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NORMS:

The high level of progesterone, a hormone produced continuously during pregnancy,

signals the brain to lower the level of carbon dioxide in the blood. As a result, a pregnant woman
breathes slightly faster and more deeply to exhale more carbon dioxide and keep the carbon
dioxide level low. She may breathe faster also because the enlarging uterus limits how much the
lungs can expand when she breathes in (Brown et al., 2016).

ANALYSIS/INTERPRETATION:

In normal pregnancy, the uterus presses on the diaphragm, making it more difficult for the
lungs to fully expand. But the patient showing symptoms of preeclampsia which is difficulty of
breathing. Long term hypertension can cause the heart to work harder to deliver blood to the body
which causes narrowing and stiffness of the pulmonary artery which makes the patient breath
more difficulty. Preeclampsia is also contributing in developing acute pulmonary edema due to
fluid retention occurs in preeclampsia which also make the patient experienced DOB.

VIII. CIRCULATORY STATUS

Antepartum

Blood pressure of the patient for the first two hours of admission was elevated. Magnesium
Sulfate and Hydralazine were given but still patient’s blood pressure remained high for the next
assessment. Irregularities in the pulse rhythm and pattern were observed.

Postpartum

Patient’s blood pressure was still above the normal range. Pulse rate was normal, but it
was still rapid and irregular in pattern.

DATE TIME BLOOD PRESSURE ANALYSIS

January 28, 2019 (Ante-partum) 10:20 am 180/120mmHg Above normal

10:35 am 190/100mmHg Above normal
11:00 am 190/100mmHg Above normal
4:35pm 110/80mmHg Normal

January 29, 2019 (Post-partum) 3:00 pm 130/90mmHg Above normal

DATE TIME PULSE RATE ANALYSIS

January 28, 2019 (Ante-partum) 10:20 am 84bpm Normal

10:35 am 92bpm Normal
11:00 am 89bpm Normal

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 January 29, 2019 (Post-partum) 3:00 pm 91bpm Normal

NORMS:

Normal cardiac rate for an adult is 60-100 beats per minute while the normal blood
pressure is 120/80 mmHg. During pregnancy, the woman’s heart must work harder because as
the fetus grows, the heart must pump more blood to the uterus. The amount of blood pumped by
the heart (cardiac output) increases by 30 to 50%. As cardiac output increases, the heart rate at
rest speeds up from a normal prepregnancy rate of about 70 beats per minute to 80 or 90 beats
per minute. Then during labor, it increases by an additional 30%. Irregularities in heart rhythm
may appear because the heart is working harder. Blood pressure usually decreases during the
2nd trimester but may return to a normal prepregnancy level in the 3rd trimester (Brown et al.,
2016).

ANALYSIS/INTERPRETATION:
Increased in the heart rate is due to pain during labor contractions. In preeclamptic
patients, there is a widespread vasoconstriction in the peripheral arterioles resulting to decrease
flow in the uterine arteries which is responsible for the endothelial dysfunction. This abnormality
will result to increased or elevated blood pressure.
IX. NUTRITIONAL STATUS

Ante-partum

The patient was in nothing per Orem during her labor. She’s with ongoing IVF D5LR 1L at
right hand regulated at 15 drops per minute. Patient’s weight prior to pregnancy is 59kg. During
gestation, patient weighs 65kg. She stands 5 feet tall. Patient’s BMI is 27.92.

Post-partum
The patient’s diet was DAT (diet as tolerated).
NORMS:
Nutritional status represents the balance between the nutritional and energy needs of the
body for carbohydrates, proteins, fats, vitamins, and minerals, and the consumption of these
nutrients. Four major types of homeostatic responses can help to maintain tissue levels when
dietary intakes are low: use of body stores (applicable to most vitamins and minerals), an
increased absorption of the nutrient (e.g., calcium, iron, zinc, magnesium, copper, and carotene),
reduced excretion in urine (e.g., of sodium and calcium), and a slowing down of nutrient utilization
or turnover (e.g., of protein). Physiologic changes that occur in pregnancy stimulate some of these
homeostatic responses, regardless of the nutritional status of the mother, thereby increasing the
supply of nutrients to help meet increased demands
Normal Body Mass Index for pregnant women ranges from 18.5-24.9 with a normal weight gain
of 25-35lbs (US Institute of Medicine, 2015)

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ANALYSIS/INTERPRETATION:

Before gestation, patient’s body mass index was above the normal range (25.35). During
pregnancy, she gained 6kg making her BMI as 27.92 which is classified as overweight.

X. ELIMINATION STATUS

Patient usually defecates 1-2 times a day with a formed brown stool and urinate more than
four times per day. Prior to delivery, she was on an indwelling Foley catheter with a urine output
of 70ml for 2 hours. Urine was light yellow in color.

NORMS:

A pregnant individual usually eliminates one to three to five times a day and urinates 30-60
cc/hour. Activity of the kidneys normally increases when a person lies down and decreases when
a person stands. This difference is amplified during pregnancy—one reason a pregnant woman
needs to urinate frequently while trying to sleep. Late in pregnancy, lying on the side, particularly
the left side, increases kidney activity more than lying on the back. Lying on the left side relieves
the pressure that the enlarged uterus puts on the main vein that carries blood from the legs. As a
result, blood flow improves and kidney activity increases. This pressure also makes a pregnant
woman need to urinate more often and more urgently (Brown et al., 2016).

ANALYSIS/INTERPRETATION:

Physiologic changes in pregnancy had the patient experienced frequent urination. The
enlarged uterus presses the bladder reducing its usual size that’s why it is filled with urine more
quickly making the patient needs to urinate more frequent. Stool was normal.

XI. REPRODUCTIVE STATUS

Patient had her menarche at the age of 15. She’s not using sanitary napkins because as
per the patient, she’s only having her menstrual period for twice a year. Since the beginning,
patient’s menstrual cycle was irregular. She became sexually active and had her first child at the
age of 16. She had history of miscarriage during her 4 th gravida.

Few months prior to confinement, patient observed whitish vaginal discharge. Her breasts
were firm and tender.

Antepartum

Bloody show was seen during labor contractions.

Postpartum

Breasts after delivery were engorge. Vaginal discharge was observed during the follow-
up assessment. Lochia was seen dark red in color and in moderate amount.

NORMS:

The first menstruation which is menarche occurs at an average age of 9 to 17 years old.
Pregnancy may occur from stage of menarche up to cessation of menstruation period (Maternal

15
and Child Health Nursing 4th Edition by Pilliterri). During pregnancy, the amount of normal vaginal
discharge, which is clear or whitish, commonly increases. This increase is usually normal. The
breasts tend to enlarge because hormones (mainly estrogen) are preparing the breasts for milk
production. The glands that produce milk gradually increase in number and become able to
produce milk. During labor, there will be a mucus discharge with pink or brown blood indicating
that the blood vessels in the cervix are rupturing as it begins to efface and dilate (Brown et al.,
2016).

Lochia is the vaginal discharge you have after a vaginal delivery. It has a stale, musty odor
like menstrual discharge. Lochia for the first 3 days after delivery is dark red in color. For the fourth
through tenth day after delivery, the lochia will be waterier and more pinkish to brownish in color.
From about the seventh to tenth day through the fourteenth day after delivery, the lochia is creamy
or yellowish in color (Cleveland Clinic, 2018).

ANALYSIS/INTERPRETATION:

Patient became sexually active at an early stage. There were physiologic changes due to
pregnancy like the vaginal discharges and firmness of the breasts which are normal during
gestation. After delivery, it was normal for the patient to have dark red vaginal discharge (Rubra)
for a moderate amount. Patient’s breasts were engorged which signals the fullness of milk in the
breasts.

XII. SLEEP AND REST PATTERN

Ante-partum

Patient usually sleeps 5-6 hours a day only. She was experiencing difficulty of breathing while
lying down. She further explained that her sleeping pattern was disturbed due to her frequent
headache. Prior to confinement, she only had 3 hours of sleep because of abdominal pain and
severe headache.

Post-partum

Patient didn’t have much sleep after delivery. She complained of dizziness and headache. The
unusual noise and people of the hospital environment contributed to the disturbance of her sleep
and rest periods.

NORMS:

A person usually sleeps for about 7 to 9 hours a day and takes a rest using some of activities
that will help you to relax including reading, watching television and others. Sleep refers to altered
consciousness with general slowing of physiologic process while rest refers to relaxation and
calmness, both mental and physical (Popper et al., 2007).

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ANALYSIS/INTERPRETATION:

The patient has an alteration in comfort measures due to environmental factors. Patient’s
blood pressure was high which affects the blood-brain barrier resulting in excess pressure on the
brain which can cause blood to leak from the blood vessels in this organ and could be the reason
of headache and dizziness.

XIII. STATE OF SKIN AND APPENDAGES

Ante-partum

Patient has a brown complexion. During assessment, she had cold clammy skin. Her hair was
thick, dry and black in color and equally distributed. The color of her conjunctiva was pale, and
the sclera was yellowish-white in color. Her nails were untrimmed with no presence of nail
clubbing. The color of her nail beds, palm of the hands and soles of foot were pale. Her capillary
refill returns after 2 seconds. Presence of striae gravidarum, linea negra, chloasma and vascular
spiders were noted in some areas of the body. There were presence of puffy eyes and edema in
both hands. Bipedal pitting edema was observed (Grade 1: 2mm, 5 seconds).

NORMS:

Mask of pregnancy (melasma) is a blotchy, brownish pigment that may appear on the skin
of the forehead and cheeks. The skin surrounding the nipples (areolae) may also darken. A dark
line commonly appears down the middle of the abdomen. These changes may occur because the
placenta produces a hormone that stimulates melanocytes, the cells that make a dark brown skin
pigment (melanin). Pink stretch marks sometimes appear on the abdomen. This change probably
results from rapid growth of the uterus and an increase in levels of adrenal hormones. Small blood
vessels may form a red spiderlike pattern on the skin, usually above the waist. These formations
are called spider angiomas. Thin-walled, dilated capillaries may become visible, especially in the
lower legs (Brown et al., 2016)

ANALYSIS/ INTERPRETATION:
Physiological changes happen especially during pregnancy like abdominal striae and
hyperpigmentation. Striae in the abdomen formed in response to the elevated glucocorticoids
level during pregnancy. High blood pressure makes your heart worker harder than it needed to
before which allows fluid to retain or can cause more fluid to leak out of the blood vessels into the
tissues causing edema.

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 6. Laboratory and Diagnostic Procedures

LABORATORY INDICATION FINDINGS REFERENCE INTERPRETATIONS NURSING RESPONSIBILITIES

AND DIAGNOSTIC VALUE
PROCEDURES
HEMATOLOGY Indicated for laboratory Hemoglobin - Explain the procedure,
assessments of blood formation 133 -120-153 g/L -normal why it is done and its
Date: and to detect any blood purpose.
01-28-19 associated disorders. Hematocrit - Increased intake of foods
0.424 -0.350-0.450 vol% -Normal high in iron such as green
leafy vegetables, eggs,
RBC broccoli…
5.16 -3.9-5.70 x10^12 /L -Normal - Take FeSO4 as
prescribed
MCV - Provide bed rest
82.2 -80-96 fl -Normal

MCHC
32.4 -33.4-3.35 -low may be caused by
iron deficiency
MCH
25.8 -27.5- 33.2 pg -low, may be caused by
iron deficiency
WBC
18 -4.5-11 x 40^ g/L

18
 -high, indicating infection
or inflammation; may be
due to emotional stress
POLYS -55-63%
90.2 high, indicating infection
or inflammation or may
be due to emotional
stress

LABORATORY INDICATION FINDINGS REFERENCE INTERPRETATIONS NURSING RESPONSIBILITIES

AND DIAGNOSTIC VALUE
PROCEDURES
BLOOD Provide important information -FBS - Explain the procedure,
CHEMISTRY about the function of the kidneys 4.45 -3.9-6.1 mmol/L Normal why it is necessary.
and other organs. -BUN - Monitor client
Date: Tests measures levels of 3.03 -2.9-8.2 U/L Normal - Attend needs
01-28-2019 important electrolytes and other -CREATININE
chemicals such as blood 67.18 -53.0-106.0 umol/L Normal
glucose, electrolytes, enzymes, - SGOT/AST
hormones, lipids (fats), other 19.10 -5.0-34.0 U/L Normal
metabolic substances, and -SGPT/ALT
proteins. 6.0 -0.0-55.0 U/L Normal

19
Diagnostic/ Indication/ Date Findings Interpretations
Laboratory Purposes
Procedure
allows quick visualization of the female 01/28/2019 There is a single live intra uterine fetus NORMAL PELVIC UTZ
PELVIC UTZ pelvic organs and structures including presently cephalic, with cardiac activity of 155 FINDINGS
the uterus, cervix, vagina, fallopian BPM and with active somatic motion on real
tubes and ovaries. time study

BPD, HC, AC, FC are compatible with 32

weeks 6 days AOG with an estimated fetal
weight of 1.9kgs

Placenta is anterior in location with maturity

grading of 2. No hematoma formation or
separation seen.

7. Surgical Procedures

20
 8. Pathophysiology

Pathophysiology (Book-based)

MODIFIABLE NON-MODIFIABLE

Weight Age
Gender
Diet Race
Lifestyle Family history of hypertension
Family history of pre-clampsia
Alcoholic

The woman’s body reacts to

trophoblastic pregnancy

Generalized vasospasm

Endothelial damage Vasoconstriction

Abnormal clotting Decreased blood flow Fluid moves out of

factor blood stream and
into interstitial
Small clots cause spaces
Deceased blood flow
oragan damage
(Liver)

Generalized edema and

organ edema

Elevated blood Decreased oxygen to

pressure every organ

PRE-ECLAMPSIA

21
 Pathophysiology (Patient-based)

MODIFIABLE NON-MODIFIABLE

Weight: overweight Age: 35

Gender: Female
Diet
Race
Lifestyle Family history of
hypertension

Hypertension

Signs and symptoms

Severe headaches
Nausea
Restless
Yellowish sclera
Difficulty of breathing
Edema
Increased blood pressure

Laboratory test revealed

Low MCHC:32.4
low MCH 25.8
high WBC:18
high Polys: 90.2

PRE-ECLAMPSIA

22
 B. PLANNING

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EXPECTED

OUTCOME
Subjective: INDEPENDENT After 1 hour of proper
➢ Monitor vital signs ➢ To identify significant nursing interventions,
“Hindi po ako Ineffective Within 1 hour of particularly respiratory changes in the patient verbally
makahinga ng breathing proper nursing rate including the depth respiratory rate reported feeling
maayos. Nahihirapan pattern related interventions, and characteristic. comfortable when
ako.” As verbalized by to patient will verbally ➢ To promote comfort and breathing
the patient. vasoconstriction report feeling ➢ Assist the patient in relaxation.
of the blood comfortable when turning and provide a
vessels breathing. comfortable position
Objective: secondary to such as semi fowler ➢ To provide comfort.
hypertension.
- Dyspnea ➢ Teach the patient on
- Use of using of relaxation
accessory muscles techniques, deep ➢ To prevent crowding of
(exerts more effort) breathing exercise. the diaphragm
- Malaise
- Restless ➢ Encourage small
- Irritated frequent meals.
Vital Signs;

23
 DEPENDENT ➢ For the management of
BP: 190/100 mmHg ➢ Regulate and monitor the underlying
Temp: 36.8 °C the oxygen as ordered respiratory distress
PR: 89bpm by the physician.
RR: 28cpm
➢ Give medications as per
doctor’s order.
➢ To relax the airway
COLLABORATIVE smooth muscles
Provide respiratory
medications and oxygen as
per doctor’s order.

24
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EXPECTED OUT
COME
Subjective: Ineffective tissue Within 4 hours of INDEPENDENT After 4 hours of
“ nahihilo ako perfusion related rendering proper ➢ Monitor blood ➢ to identify physical rendering proper
masakit batok ko“ as to nursing pressure hourly or responses associated nursing interventions
stated. vasoconstriction interventions client per doctors order with medical conditions will be able to
of the blood will be able to ➢ Perform assistive ➢ Range of motion increased tissue
Objective: vessels manifest increased passive range of exercises promotes perfusion, as
- BP: 190/100 tissue perfusion by: motion like pedal good circulation evidence by:
mmHg Scientific • BP form exercise. • BP lowers
- Bipedal edema rationale: 190/100 ➢ Restrict fluids intake ➢ to limit fluid retention down
was observed Preeclampsia is mmHg to into 1000 ml/day from190/100
(Grade 1: 2 mm, having high blood 140/90 ➢ Elevate feet when ➢ to lessen fluid mmHg to
5 seconds) pressure during mmHg sitting accumulation in the 140/90 mmHg
- Capillary refill pregnancy that • BMI within lower extremities • BMI within the
returns after 2 damages other the range of ➢ Provide quiet and ➢ it conserves energy / range of 18.5-
seconds organs, usually 18.5-24.9 restful environment lowers tissue oxygen 24.9
- Weak in the kidneys and demand
appearance liver. ➢ Provide comfort ➢ decrease discomfort
- Headache The oxygen and measures like may reduce sympathetic
- Blurry vision nutrients position on a semi- stimulation
- Vital signs: subsequently fowler’s position. ➢ it helps reduce stressful
T - 36 °C diffuse from the ➢ Do relaxation stimuli, thereby
P - 84 bpm blood into the techniques like decreases blood

25
R - 20 cpm interstitial fluid watching tv and pressure
and then into the listening to music,
body cells. deep breathing
Insufficient arterial exercise and
blood flow causes listening patients
decreased complains.
nutrition and DEPENDENT
oxygenation at the ➢ Administer ➢ to aid in lowering blood
cellular level. medications like pressure and improve
diuretics, beta the health status of the
antagonists, calcium patient
channel blockers,
and vasodilators as
prescribe by the
physician.
COLLABORATIVE
➢ Instruct and ➢ this restrictions help
implement to patient manage fluid retention
dietary restrictions in and decrease
sodium, fat and myocardial; workload.
cholesterol

26
ASSESSMENT DIAGNOSS PLANNING INTERVENTION RATIONALE EXPECTED
OUTCOME
Disturbed Within 2 shifts, the INDEPENDENT After 2 shifts, the
“di ako makatulog, sleeping pattern patient will achieve ➢ Assess client's sleep ➢ To determine the patient will achieve
minsan tatlong oras related to optimal amount of patterns and usual etiology of the optimal amount of
lang tulog ko dahil sa symptoms of sleep as evidenced bedtime rituals and disturbance. sleep as evidenced
sobrang sakit ng ulo at preeclampsia by rested incorporate these into the by rested
tiyan ko” such as appearance, plan of care. appearance,
headache and verbalization of ➢ Provide measures to take ➢ Simple measures can verbalization of
Objective Cues: abdominal pain feeling rested, and before bedtime to assist increase quality of feeling rested, and
- Dark circles under improvement in with sleep (e.g., quiet time sleep. Carbohydrates improvement in sleep
eyes sleep pattern. to allow the mind to slow cause release of the pattern.
-weak in appearance down, carbohydrates neurotransmitter
-Dozing such as crackers, or a serotonin, which helps
-Frequent yawning back massage). induce and maintain
- hyporesponsiveness ➢ Position comfortably for sleep
-Vital signs taken sleep. Elevate head using
BP: 190/100 3 pillows ➢ Clients have reported
T - 36 °C that uncomfortable
P - 84 bpm positions and pain are
R - 20 cpm common factors of

27
➢ Avoidance intake of sleep disturbance
caffeine
➢ Reduce irregular or long- ➢ Caffeine can interfere
time naps with sleep.
DEPENDENT ➢ To enhance sleeping at
➢ Administer medication night
that can induce sleep
such as sedatives as ➢ To induce sleep
ordered.

28
 B. Implementation

Name of Drugs Route, Mechanism of Action Indication/ Side Effects Nursing Responsibilities
dose and Contraindication
frequency
Generic Name: 4g, IV now Magnesium is an essential Indication CNS: • Monitor knee-jerk reflex
Magnesium element for muscle contraction. -Constipation Weakness, beforerepeated parenteral
Sulfate Mg depresses the CNS and Torsades depointes drowsiness, dizziness, administration.
Brand Name: controls convulsion by blocking -cerebral edema fainting, sweating, • Monitor serum magnesium
Martham the release of acetylcholine at -Hypomagnesaemia decreased DTR levels.
the myoneural junction. - Seizures Respiratory: • Discontinue if diarrhea or
Drug -hypothyroidism Decreased respiratory cramping occurs.
Classification: -Pre-eclampsia rate • Report sweating, flushing,
Antiepileptic, Contraindication CV: Palpitations muscle tremors or twitching,
Laxative; - Allergy to magnesium products GI: inability to move extremities.
Mineral, -Abdominal pain Excessive bowel • w/o for signs and symptoms of
electrolyte - Nausea and Vomiting activity, perianal hypocalcemia
replacement. -Acute surgical abdomen irritation • give antidote (calcium
-Fecal impaction Metabolic: gluconate) for magnesium
-Intestinal and biliary tract Magnesium intoxication as ordered.
obstruction intoxication,
-Hepatitis hypocalcemia with
-Myocardial damage- Heart tetany
blocks
-2 hr preceding delivery

29
Name of Drugs Route, Mechanism of Action Indication/ Side Effects Nursing Responsibilities
dose and Contraindication
frequency
Generic Name: IV, q2 it blocks the action of Indication -Constipation • Increased fluid intake to 2L/day
HNBB / Availability: acetylcholine on the receptors -Spasm in the -dryness of the mouth • Encourage patient to void
Hyoscine-N- Tablet 10 found within the smooth muscle -genitourinary tract with difficulty in • Monitor BP
butylbromide mg, Ampule of the gastrointestinal and -Spasm in the gastrointestinal swallowing • monitor cervical effacement and
Brand Name: 20mg urinary tract and thus reduces tract -thirst dilatation.
Buscopan the spasms and contractions. -Spasm in the biliary tract -eye dryness Blurred • monitor Intake and Output
This relaxes the muscle and -Colic -feeling Bloating • provide bed rest
Drug thus reduced the pain from the Contraindication -Dysuria
Classification: cramps and spasms - Myasthenia gravies -Nausea or vomiting
Antispasmodics -megacolon -Lightheadedness
-hypersensitivity to drug contents -Headache
-narrow angle glaucoma -Weakness
-prostate hypertrophy with urinary -induced labor
retention
-mechanical stenosis in the GI
tract
-tachycardia.

30
Name of Drugs Route, Mechanism of Action Indication/ Side Effects Nursing Responsibilities
dose and Contraindication
frequency
Generic Name: IV, 5mg, Acts directly on vascular smooth Indication -H/A • Monitor Bp
Hydralazine STAT muscle to cause vasodilation, -Hypertension -dizziness • check patency of the IV line
primarily arteriolar, decreasing -pre-eclampsia -palpitations • take with food
Brand Name: peripheral resistance; maintains Contraindication -tachycardia • discontinue if blood dyscrasias
Apresoline, or increases renal and cerebral -Hypersensitivity -angina pectoris occur
Novo-Hylazin flow -CAD -anorexia • Increased fluid intake of 2L/day
-mitral valvular -N&V • document and record
Drug -rheumatic heart disease -diarrhea
Classification: -nasal congestion
Vasodilator -flushing
-edema
-muscle cramps
- blood dyscrasias

31
Name of Drugs Route, dose Mechanism of Action Indication/ Contraindication Side effects Nursing Responsibilities
and frequency
Generic name: Doctor’s order Interferes with bacterial cell- Indication: CNS: • Observe 10 rights of
Cephalexin wall synthesis, causing cell It is prescribed for oral treatment Fever, headache, medication administration.
500mg, Thrice a to rupture and die. Active of selected infections caused by lethargy, paresthesia, • Assess for signs and
Brand name: day against many gram-positive susceptible bacterial strains, syncope, seizure symptoms of serious
Cephalex bacteria; shows limited especially lower respiratory tract, CV: adverse reactions including
activity against gram urinary tract, skin and soft tissue, Edema, hypotension, hypersensitivity.
Drug Adults: negative bacteria. and bone and joint infections. It is vasodilation, • During long term therapy,
Classification: 1 to 4 g P.O also used as a prophylaxis against palpitations, chest pain monitor CBC and liver,
st
1 class daily in divided Effective against a wide bacterial endocarditis in high-risk EENT: kidney function test results.
cephalosporin doses range of gram positive and a patients undergoing surgical or Hearing loss • Instruct patient to stop taking
limited number of gram- dental procedures. GI: drug and contact prescriber
Pregnancy Children: negative bacteria; Nausea, vomiting, immediately if he/she
category B 25-50mg/kg/day administered orally as the Contraindication: diarrhea, abdominal develops rash or difficulty
P.O. base or the hydrochloride cramps, oral breathing.
salt in the treatment of Hypersensitivity to cephalosporin candidiasis • Tell patient to take drug with
tonsillitis, otitis media and or does severely impaired renal Musculoskeletal: full glass of water.
infections of the function. Joint pain • Use cautiously in patients
genitourinary tract, bones Respiratory: with renal impairment,
and joints and of skin and Dyspnea history of GI Disease, elderly
soft tissues patients, pregnant and
lactating patients.

32
Name of Drugs Route, dose Mechanism of Action Indication/ Contraindication Side effects Nursing Responsibilities
and frequency
Generic name: Doctor’s order Inhibits calcium ion influx Indication: CNS: • Observe 10 rights of
across cell membrane -Essential hypertension headache, dizziness, medication administration.
Amlodipine during cardiac -chronic stable angina pectoris drowsiness, fatigue • Assess for signs and
Besylate depolarization; produces -vasospastic angina. CV: symptoms of serious
Adults: relaxation of coronary Peripheral edema, adverse reactions
Brand name: 2.5mg, 5mg, 10 vascular smooth muscle and Contraindication: angina, bradycardia, • Monitor patient for
mg, once a day dilates coronary arteries -Hypersensitivity to drug. hypotension, worsening angina.
Norvasc thereby decreases SA/AV Precautions: palpitations • Give sublingual
node conduction, Use cautiously in patients with; GI: nitroglycerin, as prescribed,
Drug myocardial contractility, Nausea, abdominal if patient has signs and
Classification: relaxing coronary and - Aortic stenosis discomfort symptoms of acute
vascular muscles and - Severe hepatic Musculoskeletal: myocardial infarction.
Calcium Channel decreasing peripheral impairment Muscle cramps, muscle • As appropriate, review all
Blocker resistance. - Heart failure pain or inflammation other significant adverse
- Elderly patients Respiratory: reactions, especially those
- Pregnant and lactating Dyspnea, wheezing related to the drugs and
mothers Skin: behaviors mentioned above.
- children Rash, pruritis, urticaria,
flushing

33
Name of Drugs Route, dose Mechanism of Action Indication/ Contraindication Side effects Nursing Responsibilities
and frequency
Generic name: Doctor’s order Anti-inflammatory analgesic Indication: CNS:
Mefanamic acid and angtipyretic activities It is prescribed to relieve headache, dizziness, • Observe 10 rights of
500mg related to inhibition of moderate pain when therapy will insomnia medication administration.
Brand name: prostaglandin synthesis; not exceed 1 week. SKIN: • Assess for signs and
Ponstel exact mechanisms of action Rash, pruritis, sweating symptoms of serious
Drug are not known. Contraindication: GI: adverse reactions
Classification: Nausea, , diarrhea, • Assess pain scale
Hypersensitivity to mefanamic abdominal cramps, • Educate patient regarding
NSAID acid, aspirin allergy, and as constipation desired and adverse effects
treatment of perioperative pain Respiratory: • Give drug with food, milk or
with coronary artery bypass Dyspnea, hemoptysis, antacids.
grafting pharyngitis • Do not increase or double
Other: the dose, follow the doctor’s
Peripheral edema, prescription.
anaphylactoid reactions • Document accordingly
to anaphylactic shock
• Monitor for adverse effects

34
 2. Medical Management

Medical Date performed/ General description Indication/ purpose Client’s reaction to Nursing responsibilities
management Date discontinued treatment
treatment
• Intravenous Fluid Performed: a sterile, nonpyrogenic solution - needing extra calories Client was able to -Regulated prescribed
of 5% Lactated 1-28-19 for fluid and electrolyte who cannot tolerate fluid tolerate the gtts/minute
Ringer’s solution replenishment and caloric supply overload. treatment well, with -Check for patency and
1Ll x 10-15 gtts/ in a single dose container for - prevent dehydration to the no signs of Distress regulated properly.
min. intravenous administration. patient. or adverse reaction - Ensure safety and comfort
- Check the site if there is a
a sterile, nonpyrogenic solution of present of inflammation. if
magnesium present apply cold compress
sulfate heptahydrate and -check the DTR of the
dextrose in water for injection. patient. Report to the
physician if DTR is absent.
•
D5W 500cc of 20g Performed A treatment that provides you with - prevention and control of
mgSo4 to run for 1-28-19 extra oxygen, a gas that the body seizures in preeclampsia
50cc/hr via soluset needs to work well. This may help and eclampsia.
function better and be more
active.

35
• O2 Inhalation Performed: Oxygen therapy helps to Relief from Difficulty of Patient breathe - Ensure that the canula is
(Oxygen 1-28-19 decrease shortness of breath and breathing comfortably intact to the patient nose and
Therapy) per fatigue. Achieving targeted the lace is snugly
nasal cannula. percentage of oxygen saturation. -Monitor the regulation of the
canula/oxygen
-check the humidifier. Fill it if
empty.

4. DIET

Type of Diet Indication

Low fat diet Reduce your risk of heart disease and stroke, diabetes and certain types of cancer. There are other
conditions in which a low-fat diet of use, such as gallstones.
Low sodium diet The sodium-controlled diet is used to treat many medical conditions including hypertension, congestive
heart failure, cirrhosis of the liver, kidney disease, and other fluid-or sodium-retaining conditions.
Iron It helps to make extra blood (hemoglobin) during pregnancy. Iron also helps move oxygen from lungs to
the rest of the body and to the baby.
Low protein Is a diet in which people reduce their intake of protein. A low- protein diet is prescribed for those with
inherited metabolic disorder. Because the kidney can’t filter a huge amount of protein.

36
 5. Type of Exercise General Description Indication/Purpose Clients Response

Deep breathing exercise Inhale through your nose and exhale It is important to take an active role in your The patient will be relieved and
through your mouth. Keep your recovery. One way to do so is by doing deep feel more comfortable.
shoulders relaxed and don't shrug breathing exercises. Deep breathing keeps
them. When you have filled and your lungs well-inflated and healthy while
emptied your lower lungs 8 to 10 you heal. Many people feel weak and sore
times, add the second step to your after delivery and taking big breaths can be
breathing: Inhale first into your lower uncomfortable. But if you do not do deep
lungs as before and then continue breathing after delivery, you may develop
inhaling your upper chest. lung problems, like pneumonia.

Passive range of motion This exercise help to keep a person’s The exercise help you move all the person’s The patient will be able to move
joints flexible even if she cannot move joints through their full range of motion. their joints. And reduce muscle
by herself. tension.
Walking Stand slowly and you move forward This exercise is one of the main gaits of Patient able to strengthen her
by putting one foot in front of the other locomotion. The body vaults over the stiff muscle and improves muscle
in a regular way. limb. This exercise is used to increase body tone
mobility and functionality. It also helps to
promote muscle function and increase
tolerance for body capacity in exerting effort
and activity.

37
 D. EVALUATION

✓ Patient reported feeling of comfortable when breathing.

✓ Patient manifested increased tissue perfusion as evidenced by blood pressure
reading of 140/90 mmHg.
✓ Patient achieved optimal amount of sleep as evidenced by rested appearance,
verbalization of feeling rested and improvement in sleeping pattern.

Client who had preeclampsia was instructed to take the following plan for discharge:

Medications:
• Take the medications as prescribed by the physician. Contact your healthcare provider if you think
your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any
medicine.
• Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and
why you take them. Bring the list on follow-up visits. Carry your medicine list with you in case of
an emergency.
Exercise:
• Flexibility
• Walking
• Deep breathing exercise

Treatment
• Instructed to take all the medicines prescribed by the Doctor, follow the correct medication, the
time and frequency of taking those medications.
Health Teaching:
• Eat healthy and nutritious foods like fruits and vegetables.
• Maintain proper personal hygiene.
• Perform range of motion exercises/ambulation slowly and with resistance.
• Adequate rest and sleep
Out-patient department (check-up)
• Instructed the patient to follow the order of the physician in ensuring the continuity of management
and treatment
Diet:
• Diet that low in cholesterol, sodium and fats.
• Food that rich in vitamins and minerals.

III. Conclusion

On the patient’s part, she was able to have a better understanding about her health status.
She understood the importance of following the doctor’s orders to continue the treatment, realized
the importance of eating foods that rich in low fat, low sodium, low protein, iron and food rich in
vitamins and minerals. Our patient was an open book to learn to us, as we got an opportunity in

38
learning through involving patient care, treatment, divisional therapy and teaching not only from
patient but also from his family member. We learned personal quality of patient and use the
information in treating her we also though the families, socio cultural, economic, religious and
traditional beliefs of the patient which influence her health.

After our exposure in emergency room, as student nurses, the group established good nurse-
patient rapport, unity, teamwork and effective collaboration with our groupmates. We were able
to enhance our skills, knowledge, attitude and rendered appropriate nursing interventions based
on patient’s health problems and needs. The group emphasized and able to give proper health
teachings that will help to improve the general health condition of the patient. Emergency room
served as a companion for us to be a more efficient and effective nurse with a good clinical eye
in having an accurate assessment findings to formulate and prioritized appropriate nursing
diagnoses, plan effective patient care management, implement the proper nursing interventions
to resolve the patient’s identified health problems and evaluate the effectiveness of care rendered.
After handling patient who had a Chronic Hypertension with Superimposed Preeclampsia, we
learned a lot about the manifestations, risks factors, etiology, pathophysiology, proper
management and treatment.

Based on the data compiled in this case study, we therefore conclude that all the objectives and
goals were achieved.

IV. Recommendations

A. Student Nurse

To our fellow student nurses, a case study is an essential tool that will serve as an educational
companion to have a better understanding about specific cases including Chronic Hypertension
with Superimposed Preeclampsia. Case studies will help us to be more aware of different causes,
risk factors, pathophysiology, therapies and treatments on different cases. To establish a
therapeutic nurse-patient relationship is also like building an effective collaboration with your
groupmates. Sacrifice of time, unity, teamwork, patience, trust, prioritization, and focus are
necessary things to accomplish a good case study.

B. Patient

Patient must have a healthy lifestyle. Lifestyle should be change into appropriate one: Patient
should eat more foods that rich in low fat, low sodium and low protein, iron and food rich in vitamins
and minerals such as whole grains, poultry eggs, fish and nuts. Drinking plenty of water to
maintain the hydration of the body is also needed. Patient needs adequate rest and sleep. Most
important is patient must continue the treatment and take the medications as prescribed by the
physician. Daily exercise is also essential. Most importantly, is to have a healthy lifestyle and
proper care.

39
V. Review of Literatures

Clinical outcomes in neonates following maternal magnesium sulfate therapy in

preeclampsia/eclampsia

Magnesium sulfate therapy (MST) is the method of choice in prophylaxis and treatment of
eclamptic seizures in many countries. A lot of high-quality clinical trials and meta-analyses proved
its efficacy and safety for mothers. But the effect of maternal MST on the fetus and neonate is still
controversial. The goal of the study was to analyze available trials concerning this problem in
order to prove statistically that maternal MST given as prophylaxis or treatment of eclamptic
seizures has no adverse effects on the mature fetus and term neonate. Trials were searched for
in the PubMed database among English-language articles published in 1990 to 2010. Analysis
includes randomized controlled prospective clinical trials comparing MST with no treatment,
placebo or other anticonvulsant. The following neonatal outcomes were chosen as the main
endpoints of the study: neonatal death, neonatal hypotonia, Apgar score <7 at 1 and 5 minutes,
intubation at place of delivery, admission to the NICU, treatment in NICU >7 days. The total effect
of MST was measured as the relative risk of adverse outcome in the MST group compared with
control and its 95% CI. Meta-analysis of neonatal outcomes was performed under a random-effect
model for seven endpoints and a fixed-effect model for three endpoints. Neonatal mortality in the
MST group was compared with different control groups. Each of these studies showed no
significant difference between two groups: MST/mixed (0.89, 95% CI 0.80 to 0.99), MTS/no
treatment-placebo (0.99, 95% CI 0.93 to 1.05), MTS/diazepam (1.09, 95% CI 0.91 to 1.29),
MTS/fenitoin (0.75, 95% CI 0.56 to 1.02). The neonatal hypotonia rate is significantly higher in
the MST group (3.57, 95% CI 2.89 to 4.42), although significant heterogeneity of the control group
may be a valuable confounding factor. There was no evidence for changing incidence of Apgar
<7 at 1 and 5 minutes in the MTS group compared with control (0.79, 95% CI 0.70 to 0.89 and
0.80, 95% CI 0.64 to 0.99 correspondingly). The same results were observed for intubation at
place of delivery (1.04, 95% CI 0.90 to 1.29) and admission to NICU (0.96, 95% CI 0.85 to 1.08).
The incidence of treatment in the NICU >7 day was significantly lower in MST group than in control
(0.54, 95% CI 0.52 to 0.78). Maternal MST given as prophylaxis or treatment of eclamptic seizures
does not affect neonatal mortality and incidence of neonatal hypotonia, Apgar <7 at 1 and 5
minutes, intubation at place of delivery and admission to the NICU in a population of term
newborns. Maternal MST significantly reduces the risk of neonate treatment in NICU >7 days in
this population.

Critical Care201216 (Suppl 1) :P319

https://doi.org/10.1186/cc10926
© Tikhova et al.; licensee BioMed Central Ltd. 2012
Retrieve from: https://ccforum.biomedcentral.com/articles/10.1186/cc10926

40
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16;377(9774):1319-30.

Retrievedfrom:
https://www.doh.gov.ph/sites/default/files/publications/DOH_Annual_Report_2015_07132016.co
mpressed.pdf

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